Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Howard Hao Lee; Ben-Shian Huang; Min Cheng; Chang-Ching Yeh; I-Chia Lin; Huann-Cheng Horng; Hsin-Yi Huang; Wen-Ling Lee; Peng-Hui Wang

doi:10.3390/ijerph17061825

Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Int J Environ Res Public Health. 2020 Mar 11;17(6):1825. doi: 10.3390/ijerph17061825.

Authors

Howard Hao Lee^{1

2}, Ben-Shian Huang^{1

2}, Min Cheng^{1

2}, Chang-Ching Yeh^{1

2}, I-Chia Lin^{1

2}, Huann-Cheng Horng^{1

2}, Hsin-Yi Huang³, Wen-Ling Lee^{4

5

6}, Peng-Hui Wang^{1

2

4

7

8}

Affiliations

¹ Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
² Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan.
³ Biostatics Task Force, Taipei Veterans General Hospital, Taipei 112, Taiwan.
⁴ Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan.
⁵ Department of Medicine, Cheng-Hsin General Hospital, Taipei 112, Taiwan.
⁶ Department of Nursing, Oriental Institute of Technology, New Taipei City 220, Taiwan.
⁷ Department of Medical Research, China Medical University Hospital, Taichung 440, Taiwan.
⁸ The Female Cancer Foundation, Taipei 104, Taiwan.

Abstract

Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy without identifying risk factors. Therefore, the purpose of this study is to conduct a systematic review and meta-analysis of randomized control trials (RCTs) comparing concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening. We systematically searched Embase, Pubmed, and Cochrane Collaboration databases for randomized controlled trials (RCTs) comparing intracervical Foley catheter plus intravaginal misoprostol and intravaginal misoprostol alone using the search terms "Foley", "misoprostol", "cervical ripening", and "induction" up to 29 January 2019. Data were extracted and analyzed by two independent reviewers including study characteristics, induction time, cesarean section (C/S), clinical suspicion of chorioamnionitis, uterine tachysystole, meconium stain, and neonatal intensive care unit (NICU) admissions. Data was pooled using random effects modeling and calculated with risk ratio (RR) and 95% confidence interval (CI). Pooled analysis from eight studies, including 1110 women, showed that labor induction using a combination of intracervical Foley catheter and intravaginal misoprostol decreased induction time by 2.71 h (95% CI -4.33 to -1.08, p = 0.001), as well as the risk of uterine tachysystole and meconium staining (RR 0.54, 95% CI 0.30-0.99 and RR 0.48, 95% CI 0.32-0.73, respectively) significantly compared to those using intravaginal misoprostol alone. However, there was no difference in C/S rate (RR 0.93, 95% CI 0.78-1.11) or clinical suspicion of chorioamnionitis rate (RR 1.22, CI 0.58-2.57) between the two groups. Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone.

Keywords: induction; intracervical Foley catheter; intravaginal misoprostol; labor; term pregnancy.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Administration, Intravaginal
Catheterization*
Cervical Ripening*
Cesarean Section
Female
Humans
Labor, Induced
Misoprostol / administration & dosage*
Oxytocics / administration & dosage*
Pregnancy
Randomized Controlled Trials as Topic

Substances

Oxytocics
Misoprostol